Traitement de l’hyperthyroïdie par l’iode 131 : à propos de 280 cas

We report through this work the experience of nuclear medicine department at Ibn-Sina hospital (Rabat), in the treatment of hyperthyroidism with iodine-131. We retrospectively studied a cohort of 280 patients with hyperthyroidism, from several regions of Morocco between January 2001 and January 2010. A clinical examination and a serum assessment of TSHus, FT4 and FT3 have been made at baseline and at 3, 6, 12 and 24 months after radioiodine therapy. The activity of iodine-131 administered ranged from 296 to 740 MBq and depended on the pathology being treated, age, thyroid volume, intensity of clinical and biological hyperthyroidism and socioeconomic situation. Radioiodine therapy has often been proposed as a treatment for second or third intention, 71 patients were initially treated with iodine-131, while 209 patients had received iodine-131 after failure of medical treatment and/or recurrence after surgical treatment. Graves’ disease was the most common etiology (60%), followed by toxic adenoma (20%), and multinodular toxic goiter (13%). The therapeutic efficacy of a single dose of radioiodine evaluated after a 6-months follow-up was 92% in Graves’ disease, 98% in toxic adenomas and 97% in toxic multinodular goiter. No acute complication was observed. Taking into account our socioeconomic context, radioiodine therapy remains the preferred treatment of hyperthyroidism in our country with good value vs. price and excellent tolerance.     

Unmet need for additional medical care for sick children in mother's view in rural Bangladesh: implications for improving child health services

While a country's health policy aims to provide health services to all who need them, very little in known about unmet need for additional medical care from users' perspectives in Bangladesh. This study examined unmet medical need (defined as whether a mother felt that, to manage sickness, her child had required medical care that was not available, regardless of reasons and medical care sought) of 2123 under-15 sick children by illness and child's socioeconomic characteristics in rural Bangladesh. The 1996 Health and Socioeconomic Survey conducted in Matlab recorded children's chronic (a disease or a condition lasting 3 months or more) and acute (a disease or a condition with a rapid onset and a short, severe course) morbidity, medical care sought to combat illness and unmet needs for additional medical services in mothers' views to manage the illness. The survey also recorded household socioeconomic data. Logistic regression was used to examine the data. The results reveal that unmet needs for additional medical care were 5.4% for children with acute illnesses, and 30.2% for children with chronic illnesses. For chronic illnesses, seeking medical care to manage illness from any health provider outside the home reduced unmet medical needs. Economic inequalities existed for both acute and chronic illnesses: the odds ratio of unmet medical needs for sick children of the least poor households was 0.42 (95% CI: 0.28-0.64) times that for sick children of the very poor households. The critically high unmet needs for children's chronic morbidity reveal that the chronic disease control programme in Bangladesh needs urgent revisiting and strengthening.     

Breast-conserving therapy versus modified radical mastectomy: socioeconomic status determines who receives what--results from case-control study in Tianjin, China

Background: Despite anecdotal evidence linking socioeconomic status and choices on surgical management in breast cancer patients in China, no scientific evaluations have ever been conducted. The objective of this study was to evaluate patient factors that influence patients’ treatment options between breast cancer patients receiving breast-conserving therapy (BCT) and modified radical mastectomy (MRM). Methods: A total of 268 stage I–II breast cancer patients treated with BCT in Tianjin Cancer Hospital, from January 2005 to January 2007, were compared with 200 randomly selected breast cancer patients (controls) treated with MRM. A personal health questionnaire (PHQ) was used to assess the factors that may affect the surgical decision making. Chi-squared test and multiple logistic regressions were used to examine factors associated with BCT. Results: BCT patients who were younger and were more likely to live in urban areas had medical insurance, higher levels of education and family income. Patients with medical insurance coverage were approximately six times more likely to receive BCT than patients without medical insurance after controlling for other potentially confounding factors. Similar results were also observed for family income. The observed differences cannot be explained by clinical aspects of their disease, such as tumor stage, estrogen receptor, and lymph node involvement. Conclusion: Breast cancer patients’ socioeconomic status, rather than their clinical condition, is the predominant factor in determining whether a breast cancer patient receives BCT or not. These results provide a snapshot on how socioeconomic status influences cancer care provision in China. Future efforts should be made towards reducing discrepancies in treatment options for cancer patients caused by social class and socioeconomic status.     

Health and disease: Exploring the relation between parasitic infections,child nutrition status,and markets

Research in bioarchaeology and among living people provides insight into the biological and biocultural consequences of subsistence, political, and economic transitions. Central to this effort is examining infectious disease, such as diarrheal disease, respiratory infections, and parasitic infections because they are an important source of nutritional and energetic stress in both past and current groups. Although infection may not always result in overt disease, frequent exposure results in biological stress with a negative effect on child growth and, by extension, health. The goal of this article is to examine the association between a common class of infectious disease, soil-transmitted helminth worms, and nutritional status among youth living in communities that vary with respect to their distance from a commercial center. In 2007, anthropometric measurements and parasitological surveys were collected for 338 2–14-year-old children and adolescents living in lowland Bolivia as part of the Tsimane' Amazonian Panel Study. Associations between the presence of helminth infections and markers of both short- and long-term nutritional status were overall weak. Youth living in communities distant from the commercial center were more likely to be positive for multiple parasite species than youth in near communities, but youth in mid-distance communities had lower infection rates. This article demonstrates the challenge of identifying associations between nutritional and disease stress when individual and household factors are nested in a larger context of socioeconomic and environmental change. Increased collaboration between bioarchaeology and human biology should continue to examine the connections between stress and disease across time. Am J Phys Anthropol 155:221–228, 2014. © 2014 Wiley Periodicals, Inc.     

The Effects of Socioeconomic Status,Clinical Factors,and Genetic Ancestry on Pulmonary Tuberculosis Disease in Northeastern Mexico

Diverse socioeconomic and clinical factors influence susceptibility to tuberculosis (TB) disease in Mexico. The role of genetic factors, particularly those that differ between the parental groups that admixed in Mexico, is unclear. The objectives of this study are to identify the socioeconomic and clinical predictors of the transition from latent TB infection (LTBI) to pulmonary TB disease in an urban population in northeastern Mexico, and to examine whether genetic ancestry plays an independent role in this transition. We recruited 97 pulmonary TB disease patients and 97 LTBI individuals from a public hospital in Monterrey, Nuevo León. Socioeconomic and clinical variables were collected from interviews and medical records, and genetic ancestry was estimated for a subset of 142 study participants from 291,917 single nucleotide polymorphisms (SNPs). We examined crude associations between the variables and TB disease status. Significant predictors from crude association tests were analyzed using multivariable logistic regression. We also compared genetic ancestry between LTBI individuals and TB disease patients at 1,314 SNPs in 273 genes from the TB biosystem in the NCBI BioSystems database. In crude association tests, 12 socioeconomic and clinical variables were associated with TB disease. Multivariable logistic regression analyses indicated that marital status, diabetes, and smoking were independently associated with TB status. Genetic ancestry was not associated with TB disease in either crude or multivariable analyses. Separate analyses showed that LTBI individuals recruited from hospital staff had significantly higher European genetic ancestry than LTBI individuals recruited from the clinics and waiting rooms. Genetic ancestry differed between individuals with LTBI and TB disease at SNPs located in two genes in the TB biosystem. These results indicate that Monterrey may be structured with respect to genetic ancestry, and that genetic differences in TB susceptibility in parental populations may contribute to variation in disease susceptibility in the region.     

Population-based analysis of obesity and workforce participation

Objective: To describe the relationship between obesity class and workforce participation and the influence of demographic, socioeconomic, and comorbid disease states on this relationship using population‐based Canadian data. Research Methods and Procedures: Responses from 73, 531 adults surveyed in the Canadian Community Health Survey 2000 to 2001 who provided complete information regarding variables of interest were analyzed. Workforce participation was defined as individuals reporting that they held and were present at a job or business in the week before survey administration. The association between obesity and workforce participation was explored using logistic regression after adjusting for demographic, socioeconomic, and obesity‐related comorbidities. Results: In univariate analysis, obese individuals had lower odds of participating in the workforce. In the fully adjusted model, increasing obesity was associated with decreasing odds of workforce participation, with Class I, II, and III obesity having odds ratios (95% confidence interval) of 0.94 (0.89 to 0.99), 0.85 (0.77 to 0.94), and 0.66 (0.57 to 0.78), respectively. Obese individuals were also less likely to be employed and more likely to be absent from work. Discussion: Obesity is associated with lower workforce participation. This association appears to be independent of associated comorbidity and sociodemographic factors. These results indicate that the economic impact of obesity alone on workforce productivity is larger than previous reports suggest.     

Climate Change and the Geographic Distribution of Infectious Diseases

Our ability to predict the effects of climate change on the spread of infectious diseases is in its infancy. Numerous, and in some cases conflicting, predictions have been developed, principally based on models of biological processes or mapping of current and historical disease statistics. Current debates on whether climate change, relative to socioeconomic determinants, will be a major influence on human disease distributions are useful to help identify research needs but are probably artificially polarized. We have at least identified many of the critical geophysical constraints, transport opportunities, biotic requirements for some disease systems, and some of the socioeconomic factors that govern the process of migration and establishment of parasites and pathogens. Furthermore, we are beginning to develop a mechanistic understanding of many of these variables at specific sites. Better predictive understanding will emerge in the coming years from analyses regarding how these variables interact with each other.     

Multiple Dimensions of Socioeconomic Position and Obesity among Employees: The Helsinki Health Study

Objective: To examine socioeconomic differences in obesity using several different socioeconomic indicators, ranging from childhood socioeconomic environment and adult socioeconomic status to material resources and economic satisfaction. Research Methods and Procedures: The data derived from the Helsinki Health Study baseline surveys in 2000 and 2001. Respondents to postal surveys were middle‐aged employees of the City of Helsinki (4, 975 women and 1, 252 men, response rate 68%). Associations between eight socioeconomic indicators and obesity (BMI ≥ 30 kg/m²), calculated from self‐reported data, were examined by fitting a series of logistic regression models. Results: In women, all socioeconomic indicators except household income and economic satisfaction were associated with obesity. Parental education and childhood economic difficulties, i.e., socioeconomic conditions in childhood, remained associated with obesity after adjusting for all indicators of current socioeconomic position. Indicators of adult socioeconomic status, own education and occupational class, were no longer associated with obesity when childhood socioeconomic conditions were adjusted for. Home ownership and economic difficulties were associated with obesity after full adjustments. In men, the findings paralleled those among women, but few associations reached statistical significance. Discussion: Obesity was associated with several dimensions of socioeconomic position. Childhood socioeconomic disadvantage was associated with obesity independently of the various indicators of current socioeconomic position. Associations between obesity and both educational level and occupational class disappeared after adjustment for other indicators of socioeconomic position. This suggests that the variation observed in the prevalence of obesity by these key socioeconomic indicators may reflect differences in the related material resources.     

Biological control of the cassava mealybug Phenacoccus manihoti (Hom., Pseudococcidae) by Epidinocarsis lopezi (Hym., Encyrtidae) in Malawi

From 1985 to 1989 five large scale surveys were made to document the spread of the cassava mealybug (CM) Phenacoccus manihoti Matile‐Ferrero (Hom., Pseudococcidae) and the releases and successful establishment of its exotic parasitoid Epidinocarsis lopezi (De Santis) (Hym., Encyrtidae) through most cassava‐growing areas of Malawi. In a multiple regression analysis involving 29 meteorological, agronomic and plant variables from 476 fields, the duration of E. lopezi's presence was the major factor influencing CM population densities. In the first year the CM was recorded in a particular place, 25% of all tips had more than 100 CM. Wherever E. lopezi had been present for two years or more, CM populations were reduced on average seven times and tips infested with more than 100 CM became rare (1%). In parallel, damage on cassava tips stabilized at a low level. Similarly, along Lake Malawi, 84.9% of all tips had more than 10 CM in 1986; this value stabilized at 3.3%‐4.0% in 1988–1989. Indigenous coccinellids were often abundant in the first year of the CM infestation, but their populations collapsed later, while the frequency of fields with E. lopezi increased. In 1987, farmers abandoned 28.4% of all fields where E. lopezi was just introduced as compared with 2.7% where the parasitoid had been present for two years or more. Overall, satisfactory control was achieved by E. lopezi in all but a few fields concentrated on extremely poor soils characterized by sand dune vegetation. The socioeconomic implications of this ongoing and apparently successful biological control program are discussed.     

Management of Fusarium oxysporum f. sp. lycopersici and root-knot nematode disease complex in tomato by use of antagonistic fungi,plant resistance and neem

Simultaneous infestation with root-knot nematodes (RKN) and Fusarium oxysporum f. sp. lycopersici (FOL) leads to formation of a disease complex that increases crop losses than effect of either RKN or FOL. In this study a management programme involving plant resistance, biological control agents, and neem was carried out to manage RKN and fusarium wilt disease complex. The biological control agents were Purpureocillium lilacinum (PL) and Trichoderma harzianum (TH) while the RKN was Meloidogyne javanica. In vitro dual culture plates were set up to test the interaction of biological control agents and FOL. Greenhouse experiments were conducted using two tomato cultivars Rambo F1 and Prostar F1. The treatments were; PL, TH, PL–TH, neem, PL neem, TH neem, and PL–TH neem. Each treatment was replicated four times and the treatments set up in a randomised complete block design in the greenhouse. Inhibition of FOL mycelial growth by TH and PL was 51.9%, and 44% respectively by the ninth day in vitro culture plates. In the cultivar, Prostar F1, the treatments PL–TH, PL, and TH in the presence or absence of neem had a FOL disease severity score significantly lower than the untreated control. Host resistance sufficed to prevent infection of Rambo F1 with FOL. The treatments PL–TH, PL and TH reduced FOL propagules and M. javanica juveniles in the roots and performed even better when combined with neem in both tomato cultivars. Therefore, a host that is resistant combined with biological control agents and organic amendments can be used in the management of RKN and FOL in tomato production.     

Use of a Hospital Emergency Service by Children and Adolescents for Primary Care

This study was planned to determine the extent to which the emergency service of a large general hospital in Vancouver was providing a primary medical care function for children and adolescents. The data were collected during 14-day study periods in each season of the year. Medical data and physician urgency rating were obtained on all patients. Demographic and socioeconomic data and data pertaining to patterns of medical care were obtained by interview of a one-third sample.The study identified a group of patients receiving primary medical care for non-urgent and non-traumatic conditions. This group resided close to the hospital and had lower socioeconomic indices than the remainder of the patients.The trend to utilize the emergency department for reasons other than the accident and emergency function was confirmed. These findings will be incorporated in the planning of the New Children''s Hospital in Vancouver with the provision of separate facilities for the care of non-urgent attenders.     

Social class,admixture, and skin color variation in Mexican-Americans and Anglo-Americans living in San Antonio,Texas

Social class may act in different ways as a barrier to gene flow in urban populations, depending on ethnicity. We test the hypothesis that biological variation is affected by social class subdivision using skin reflectance data collected for 393 Anglo-American and 930 Mexican-American adults in the major urban population of San Antonio, Texas. Two socioeconomic groups were sampled for the Anglo-American population: a middle-income transitional group and a high-income suburban group. In addition, we sampled a third socioeconomic group for Mexican-Americans: a low income barrio. Sex and age effects on skin color are minimal. Social class has no effect on skin color variation for Anglo-Americans, whereas there is a highly significant effect on social class subdivision for Mexican-Americans. Admixture estimates were derived from skin reflectance data and show that the proportion of native American ancestry decreases as social class increases.     

Inhibitory effect of Trichoderma isolates on growth of Alternaria alternata,the causal agent of leaf spot disease on sunflower,under laboratory conditions

Several species of the genus Alternaria are involved in leaf spot disease of sunflower, with Alternaria alternata being the dominant species responsible for this disease in Iran and many other sunflower-producing areas, worldwide. The disease causes a progressive destruction of the photosynthetic apparatus, resulting in annual yield loss. The routine disease management strategies are not effective for disease control; hence, alternative measures for disease management are of great interest. In the present study, the efficacy of Trichoderma harzianum T22 and Trichoderma sp. on biological control of the causal agent was evaluated under laboratory conditions. The effect of Trichoderma isolates on dry weight (DW) and radial growth (RG) rate of A. alternata was evaluated using dual culture, volatile and non-volatile cellular metabolites. The results obtained in this study revealed that in both Trichoderma isolates, non-volatile cellular metabolites had the highest inhibitory effect on DW and RG rate of the causal agent. Owing to explicit inhibitory effect of non-volatile cellular metabolites on A. alternata, the inhibitory effects of different concentrations of non-volatile cellular metabolites were evaluated on DW and RG rate of the A. alternata. The obtained results showed that non-autoclaved 75 and 50% concentrations and undiluted (100%) autoclaved non-volatile cellular metabolites from Trichoderma sp. had the highest inhibitory effect on DW and RG rate of the causal agent. The overall results of this study reveal that Trichoderma spp. have excellent efficacy on biological control of A. alternata under laboratory condition; such that, further studies on the potential of Trichoderma spp. in biological control of Alternaria leaf spot disease of sunflower under green house and field conditions are necessary.     

Temporal and Spatial Development of Papaya Ringspot in Veracruz, Mexico

The temporal progress and spatial distribution of papaya ringspot virus (PRV) and populations of aphid vectors were monitored in two papaya (Carica papaya) plantations in the state of Veracruz, México. The incidence of PRV had a typical sigmoidal curve and the logistic model was more acceptable for describing the disease progress than the Gompertz model. The rate (r^L of increase in disease incidence (0.034 and 0.023/unit/day in Plot A and B, respectively) differed (P = 0.05) between the plots; differences in number of aphids trapped could account for the difference. The initial determination of an apparent regular spatial pattern early in the epidemic, obtained with a quadrat size determined by Greig-Smith's method (n = 8 plants/quadrat) at 50 % disease incidence, was inconsistent with our biological observations in the field. An arbitrarily selected, square quadrat size (n = 9 plants/quadrat), was more consistent with visual observation for describing the spatial pattern in the field. With 9 plants/quadrat a random pattern was found. Aphid populations had a bimodal distribution at both sites with the highest population peak in December–February and a secondary peak in August–September and change in disease incidence was generally related to the aphid population level in the previous month. None of the five potential aphid vectors (Myzus persicae, Aphis gossypii A. nerii, A. citricola and Macrosiphon euphorbiae) of PRV in Mexico colonized the papaya plants, however, which may explain the absence of clustering of disease.     

Positive and negative affect and risk of coronary heart disease: Whitehall II prospective cohort study

Objective To examine the associations between positive and negative affect and subsequent coronary heart disease events independently of established risk factors.Design Prospective cohort study with follow-up over 12 years.Setting 20 civil service departments originally located in London.Participants 10 308 civil servants aged 35-55 years at entry into Whitehall II study in 1985.Main outcome measures Fatal coronary heart disease, clinically verified incident non-fatal myocardial infarction, and definite angina (n=619, mean follow-up 12.5 years).Results In Cox regression analysis adjusted for age, sex, ethnicity, and socioeconomic position, positive affect (hazard ratio=1.01, 95% confidence interval 0.82 to 1.24) and the balance between positive and negative affect, referred to as the affect balance score (hazard ratio=0.89, 0.73 to 1.09), were not associated with coronary heart disease. Further adjustment for behaviour related risk factors (smoking, alcohol consumption, daily fruit and vegetable intake, exercise, body mass index), biological risk factors (hypertension, blood cholesterol, diabetes), and psychological stress at work did not change these results. However, participants in the highest third of negative affect had an increased incidence of coronary events (hazard ratio=1.32, 1.09 to 1.60), and this association remained unchanged after adjustment for multiple confounders.Conclusions Positive affect and affect balance did not seem to be predictive of future coronary heart disease in men and women who were free of diagnosed coronary heart disease at recruitment to the study. A weak positive association between negative affect and coronary heart disease was found and needs to be confirmed in further studies.     

Effect of diet on the incidence of and mortality owing to gastritis and renal disease in captive cheetahs (Acinonyx jubatus) in South Africa

Seventy‐two adult cheetahs were evaluated for the degree of gastritis by endoscopic biopsy and for renal disease by serum creatinine. Cheetahs free of Grade 3 gastritis and renal disease were placed on Trial A; remaining cheetahs were placed on Trial B, which ran concurrently. All cheetahs were monitored for 4 years. Cheetahs exited Trial A and entered Trial B if they developed Grade 3 gastritis or renal disease. Cheetahs exited Trial B if they developed clinical gastritis or renal disease that required a dietary change or aggressive medical therapy or died owing to either disease. Cheetahs on Trial A were fed either a supplemented meat diet (N = 26) or commercial cat food (N = 22). Cheetahs on Trial B were fed either the same meat diet (N = 28) or a commercial dry cat food formulated for renal disease (N = 16). Cheetahs fed meat on Trial A had a daily hazard of developing Grade 3 gastritis 2.21 times higher (95% CI 0.95–5.15) than cheetahs fed commercial cat food. This hazard was not statistically significant (P = 0.07). Mean gastritis scores were not significantly different between the two groups. Cheetahs fed commercial cat food in both Trials had lower serum urea levels and higher creatinine levels than those fed meat. Evidence for the effect of diet in cheetahs with gastritis and/or renal disease (Trial B) was inconclusive. The number of cheetahs dying of gastritis or renal disease at the facility has dropped markedly since the study began. These results indicate that diet may play an important role in the incidence of Grade 3 gastritis and that dietary and/or therapeutic management of gastritis may reduce mortality owing to gastritis and renal disease in captive cheetahs. Zoo Biol 31:669‐682, 2012. © 2011 Wiley Periodicals, Inc.     

Cross‐Sectional and Longitudinal Associations of BMI with Socioeconomic Characteristics

Objective: To examine cross sectional and longitudinal associations of socioeconomic position and neighborhood environments with BMI in a middle‐aged and bi‐ethnic cohort. Research Methods and Procedures: Analyses were based on 13, 167 subjects (45 to 64 years) who participated in the Atherosclerosis Risk in Communities Study, a population‐based study. Census block groups were used as proxies for neighborhoods and were characterized using a summary socioeconomic score. BMI was measured at baseline and at three follow‐up visits over a 9‐year period. Results: Individual and neighborhood socioeconomic characteristics were independently and inversely associated with BMI at baseline in women [mean difference in kilograms per meter squared per unit increase in socioeconomic category (SE) for white and black women respectively; ?1.56 (0.14), ?1.59 (0.19) for education; ?1.07 (0.10), ?1.18 (0.18) for income; and ?1.04 (0.09), ?0.77 (0.18) for neighborhood characteristics]. Results for men were not as consistent. Baseline BMI was negatively associated with income in white men but was positively associated with education, income, and neighborhood characteristics in black men. BMI increased over time regardless of gender or race and in most age groups. In whites, there were no consistently patterned differences in longitudinal trends in BMI by individual or neighborhood socioeconomic characteristics. However, in blacks, there was some evidence of greater increases in the higher socioeconomic status groups. Discussion: Socioeconomic factors are inversely associated with BMI in middle‐aged women, possibly reflecting socially patterned exposures occurring in childhood and adolescence. However, recent increases over time in BMI are either not clearly patterned by socioeconomic factors or are greater in the higher socioeconomic status groups.     

Four-year follow-up of school-based intervention on overweight children: the KOPS study

Objective: To evaluate the 4‐year outcome of a school‐based health promotion on weight status as part of the Kiel Obesity Prevention Study (KOPS). Research Methods and Procedures: Within a cluster‐sampled quasi‐randomized controlled trial, 1764 children at 6 and 10 years of age were assessed between 1996 and 2005 in 32 primary schools in Kiel, North Germany. Six nutrition units followed by 20‐minute running games were performed within the first year at school. Prevalence, incidence, and remission of overweight were main outcome measures. Results: The 4‐year change in BMI was +11.6%, with increases in prevalence of overweight and obesity from 5.2% to 11.1% and 3.9% to 5.1%, respectively. Cumulative 4‐year incidence of overweight and obesity was 9.2% and 3.1%, respectively. Intervention had no effect on mean BMI. The effect on prevalence was significant in children from families with high socioeconomic status [odds ratio (OR), 0.35; 95% confidence interval (CI), 0.14 to 0.91] and marginally significant in children of normal‐weight mothers (OR, 0.57; 95% CI, 0.33 to 1.00). Cumulative 4‐year incidence of overweight was lower only in intervention children from families with high socioeconomic status (OR, 0.26; 95% CI, 0.07 to 0.87). Remission of overweight was most pronounced in children of normal‐weight mothers (OR, 5.43; 95% CI, 1.28 to 23.01). Prevalence of underweight was unchanged. The intervention had minor but favorable effects on lifestyle. Discussion: A school‐based health promotion has sustainable effects on remission and incidence of overweight; it was most pronounced in children of normal‐weight mothers and children from families with high socioeconomic status. There was no effect on obesity. The data argue in favor of additional measures of prevention.     

Stunting in pre-school and school-age children in the Peruvian highlands and its association with Fasciola infection and demographic factors

Fascioliasis is a zoonotic trematode infection that is endemic in the highlands of Peru. Chronic fascioliasis can be asymptomatic and remain undiagnosed for years. Chronic malnutrition in children, as manifested by stunting, leads to delayed cognitive development and lost productivity. We hypothesized that fascioliasis is among the factors associated with stunting in children from endemic areas. We conducted a cross-sectional study among children attending pre-school and school in 26 communities in the Anta province in the Cusco region of Peru. We conducted interviews to collect information on demographic, socioeconomic, and medical history. Blood was collected and tested for complete cell count and FAS2 ELISA for Fasciola antibodies. Three stool samples per participant were tested for parasites by Kato-Katz and Lumbreras rapid sedimentation methods. Chronic fascioliasis was determined by the presence of ova in stool. Children’s height, weight, and age were recorded and used to calculate height for age Z scores (HAZ). Three thousand children participated in the study. Nine percent (264) of children had at least one positive test for Fasciola infection, 6% (164) had chronic fascioliasis, and 3% (102) had only positive antibody tests. The median HAZ was -1.41 (IQR: -2.03 to -0.81) and was similar in males and females. Twenty six percent (776) of children had stunting with HAZ < -2. Children with chronic fascioliasis had a lower median HAZ than children without Fasciola (-1.54 vs. -1.4, p = 0.014). History of treatment for malnutrition, history of treatment for anemia, having other helminths in stool, lower socioeconomic score, living at a higher elevation, and fewer years of schooling of both parents were associated with a lower HAZ score. In a multiple regression analysis, older age and a lower socioeconomic score were associated with a lower HAZ score. While fascioliasis and other helminths were associated with lower HAZ, they were not independent of the socioeconomic score.     

Effects of nutrition on zinc, folic acid, and vitamin B12 levels during pregnancy

In this article, we report the results of a case control study carried out on 290 Turkish pregnant women at 5–24 wk of gestation to determine their zinc, folic acid, and vitamin B₁₂ levels in relation to their nutritional and socioconomic status. The women were divided into two groups (n=145 each), depending on the stage of gestation. Group I consisted of women in the first trimester of gestation; those in the second trimester were allocated into group II. Twenty-five age-matched, healthy nonpregnant women were selected as controls. The nutritional status of the subjects was determined by means of a survey. Based on this, the women were subdivided into three subgroups: malnourished (PN), moderately nourished (MN), and well nourished (WN). Also from the survey, the socioeconomic status was classified as good (G) or bad (B). A statistically significant decrease on zinc and folic acid was observed in group I women, as their socioeconomic status worsened. In group II, zinc decreased only in the PN and MN subgroups, p<0.001. The folic acid and vitamin B₁₂ levels did not change significantly during the second trimester of gestation in all subgroups. Regarding zinc, nutrition, or dietary habits are more relevant than socioeconomic status, but poor nutrition affects folic acid levels only during the first trimester of gestation.